Really unstable moods/emotions on Mirtazapine

[unspoken]

I've been taking Mirtazapine 15mg for nearly 2 weeks while coming off Sertraline (was taking 150mg, now down to 25mg).

I've been feeling mostly sedated and also depersonalisation, dizziness, clumsiness and brain fog from the Mirtazapine.

I was taking Sertraline for 6 years and mostly ok for 2 years before things all went downhill last November. I came out of a relationship and it was a lot harder than I expected. Then I met somebody who turned out to be bad news, due to his mental illness he is unstable and I have been the recipient of that instability.

I was feeling generally ok mood-wise on Friday when I saw the doctor. I got signed off work for another 2 weeks though due to the sedation and depersonalisation side effects of the mirtazapine (been signed off 3 weeks already). On Saturday night the aforementioned Mr Bad News decided to be very mean to me for no apparent reason and also blocked me on Facebook. I know he is ill but it upset me because I'd been only kind to him and tried to help him and he threw it all back in my face for reasons I won't ever understand. I was already feeling low about being signed off for even longer with no end in sight.

Saturday night after that I was crying but trying to keep a handle on things. On Sunday morning I felt really low and tearful and I couldn't see the point in getting out of bed, but I listened to some music which was reasonably effective at lifting my mood for a while. I went out for a walk for a few hours and tried to distract myself but still felt pretty low.

Sunday evening (it's now early Monday morning) I've felt really suddenly tearful. After six years on Sertraline, which mostly stopped me from ever crying (except during a panic attack), I don't know if this is a normal emotional reaction or not. I decided to call the doctors in the morning to speak to the GP since things have changed since Friday. I was just looking at Facebook and I saw that the account of two bands I follow on there had been hacked and they'd been posting silly clickbait stories. I looked at the comments on the posts and I found some of them so funny I was laughing and laughing, so much so that my face started feeling fuzzy from lack of air, and then I cried and it turned into hopelessly sad crying. This has repeated itself several times.

I don't think my laughing reaction was appropriate as the comments weren't that funny. I don't know why it then caused me to get really upset. I can't tell if this is my emotional range returning to "normal" after so long on Sertraline, or if Mirtazapine is making me go loopy, but I can't deal with it. I feel like I'm losing the plot. I haven't had much success with actually getting to see a doctor, no matter how distressed I seem. I need to try to sleep so I can get up early to call the doctors and try to get the receptionists to understand that I need a doctor to call me back.

Does anyone have any experience or advice or reassurance to give me about this? I'm desperate to feel better than this and get back to work but I feel stuck in a hole between sertraline withdrawal, mirtazapine side effects, under resourced health services and the pressures of life.

[Doze]

I replied to you in my thread, but I'll repeat it little here.

Things will get easier for you Unspoken. The Mirt foggyness will start to clear. Coming off Setraline after 6 years isn't going to be smooth sailing, but that too will get easier with time. Maybe you need to accept that you're not going to be at your best for a few weeks, but things will get slowly easier. And try not to give yourself a hard time about that.

There's only a few people on this sub, but we're here for moral support if needed.

[Shazamataz]

I expect you are having a combination of withdrawal from the sert and starting up with the Mirt.

I think the Mirt may actually be making my mood worse, but can;t be sure as I've been through such a rollercoaster it would be enough to make anyone depressed. I just know I don't like myself very much at the minute and feel very guilty that my dogs are being affected as they are such sensitive animals.

Anyway, welcome aboard the meds rollercoaster. I hope it goes smoothly for you.

[unspoken]

I got to sleep about 4am. Woke up at 8am and made 9 attempts to phone the doctors over the next hour but the number was engaged every time. I couldn't muster up the energy to get up and go round there to see them. Eventually I gave up and went back to sleep. Now I am struggling to feel awake, even though it's 14 hours since I took the Mirtazapine and I was wide awake in the early hours. I don't know how to cope with this.

Thanks for your replies, it's good to know I'm not going through this alone.

[Doze]

I think having broken sleep like that will inevitably make you feel groggy Unspoken.

What time do you think you should be falling asleep? And when are you taking the Mirt?

[unspoken]

Last night I was unsure whether I wanted to take the Mirtazapine, but in the end I took it around 11pm. I know that if I am anxious enough, I can stay awake despite IV sedation. I should probably have taken the Mirtazapine about 9pm and been in bed by 11pm, but I didn't want to go to bed because there was no point.

I went to the doctors about an hour ago and asked if I could speak to the particular GP who is treating me at the moment, as she only works there Mondays and Fridays. The receptionist wrote down my details on a post-it note and said she'd ask the doctor to call me. I am crying most of the time at the moment, I don't seem to have any control over my emotional reactions. I've written down a few notes of what to say to the doctor. I don't think the current combination is working for me, so I was thinking my options could be:
1. Take some Mirtazapine in the morning as well, perhaps 7.5mg, on top of the 15mg at night. I've read and heard from people that this can reduce the grogginess and increase its antidepressant effectiveness.
2. Go back onto the Sertraline, perhaps at 50mg, to see if it settles my emotions down.
Options 3 and 4 are what my self-destructive brain is saying:
3. Stop taking both drugs and go cold turkey
4. Take enough benzos/other sedatives that I stop caring about anything.

Option 4 is what I was doing before I started the Mirtazapine but I have been sedated so much for so long that it no longer seems appealing.

It's annoying spending the precious few daylight hours sitting inside waiting for the phone to ring :(

[Doze]

I take my 15mg dose in smaller parts over an hour or so as I found 15 at once too stimulating, and I find about an hour or so after taking the first dose I start to feel sleepy. Sometimes I can fall asleep during this period, but it doesn't last very long, and then I'm left feeling comfortable enough but waiting to just fall asleep naturally.
I tried taking smaller doses during the day to up my overall dose, but found that anything more than an 8th of a 15mg tablet had a sedating effect.

The Mirt won't knock you out like a sleeping pill will, it will only help by making you somewhat sleepy and hopefully less anxious. You need to help it along.
If you're not falling asleep till gone 4, then sleeping well into the day, your internal body clock will be confused. It wants routine to work. Which means trying to wake at the same time every day. Winding down before bed to allow your brain to turn off and know it's time to start producing melatonin and prepare for sleep. So no screens, no phones, no Facebook, nothing vaguely exciting for an hour before bedtime. Try and make a quiet time during the day to get any worries out of the way, so you're not saving them all up for when your head hits the pillow. Also, try and eat at regular intervals and eat breakfast as close to when you awake as possible - this tells your body it's time to be awake and should also help set your body clock. And lastly, try and get a good amount of daylight early in your day. Either by going outside or from a SAD light.

I think you're correct in identifying your self destructive options and so I think you know it's best to ignore them. Benzos can be a useful tool, but I think if you want to take them to completely turn off, then it just like sweeping dirt under the rug. It'll still be there and you'll have to deal with it at some point.

[unspoken]

Thank you. I spoke to the doctor and she seemed concerned and said to ring her on Friday when she's in, and ring and ask to speak to one of the other doctors if I need help before that. She said there's a good mental health team 24 hours a day in A&E, but I don't want to get to that point. I think if I was that distressed I'd just take the diazepam until I calmed down.

The doctor said to go with option 2 - back up to 50mg of Sertraline. I took the Sertraline and went out for a walk and about an hour after I took the Sertraline I felt transformed from a crying wreck into a reasonably resilient person. So I guess I need the Sertraline more than I realised. It's good to feel better again.

The plan now is to try and see if taking 50mg Sertraline in the mornings and 15mg Mirtazapine at night can balance the therapeutic effects of both - Sertraline at fighting depression and Mirtazapine at easing anxiety to help me sleep and eat. I plan to speak to my manager about trying to do some work from home at first and then in the office to give me something to focus on.

You're right Doze, thank you for the advice about going to bed properly. I tend to stay up late browsing the net and it doesn't help me. I was trying to do some cryptic crosswords from a book last night, sometimes that sends me straight to sleep. I'll try to find something that isn't too stimulating or upsetting to do before bed tonight, maybe some colouring or reading a magazine about wildlife.

[Shazamataz]

Sorry you are feeling so rough, Unspoken, me too :(

Hopefully the Sertraline will work for your mood and you will get a good sleep routine going with the Mirt.

The Mitr certainly doesn't seem to be doing anything for my sleep any more while it did help a little the first week or so. It's also stopped making me eat and I feel really nauseous/ill this morning after not being able to eat much yesterday.

It's 8 am, been awake since 5 and up since 7.30. Just want to curl up in bed and die. Not sure how I am going to get through today!

[unspoken]

Thank you. Unfortunately it's 10:15pm and I'm still on the computer. I was planning to turn it off and do something to relax, but it hasn't happened yet. I can still do better than last night though. I took the Mirtazapine about half an hour ago and I've started to yawn and feel a bit detached and my vision is blurring. Unfortunately my internet connection is dodgy so it's taking me longer to finish the things I wanted to finish as it cuts out, and then once it's back I've forgotten what I wanted to do. I hope you get through the rest of your day ok. I have been scared into sticking with the Sertraline longer, perhaps trying to come off it when the weather is better and the days are longer. This month has been a write-off for me.

I've got a couple of phone calls lined up tomorrow, one with the psychiatric therapy services, but I don't have high hopes as they say they only really provide CBT courses for low mood, no counselling or psychotherapy. I am also going to speak to my employer about doing some kind of productive work, as I feel more able to cope with things once I've had the sertraline. Thoughts that would previously have had me in floods of tears earlier or yesterday are now bearable. Not pleasant, but bearable.

[Shazamataz]

You're still online so it must be getting late!

11.45 am here and going mental. Have made an appointment to see GP this afternoon and hoping my friend can take me.

Just feeling too unwell and posted in the other thread (sorry, all over the place) I feel anything with seretonin is messing with me too much.

Pounding heart all morning, can't sleep, can't eat, feeling desperate again which is so upsetting as last week I felt I was turning a corner.

I think a part of the battle is being alone but there's not a lot I can do about that so it's a vicious cycle. I used to crave solitude and loved living alone until the past couple of months. Today I am back to dreading every moment inside these four walls.

Fingers crossed I can stop the Mirt and will start feeling normal again. Maybe try the Olanzapine again as I didn;t notice anything major with it.